Jeannine Schübel

Current vaccination status regarding measles among university students in Dresden, Germany.

Germany aimed to eliminate measles by 2015, but vaccination coverage is still insufficient, especially in respect to adolescents and young adults. A cross-sectional survey with 711 students studying a range of subjects showed a high acceptance regarding vaccination. Actual self-reported vaccination rates were lower; only 65.5% of medical students and 25.3%-39.4% of other student groups reported complete vaccination against measles. Of the students, 12.6%-45% did not know their vaccination status. Vaccination acceptance did not correlate with vaccination behavior: accessible vaccination opportunities at universities should be offered.

Latent Hypothyroidism in Adults

BACKGROUND The prevalence of latent/subclinical hypothyroidism is between 3% and 10%, according to epidemiologic studies that have been carried out in the USA, the United Kingdom, and Denmark. As persons with latent hypo - thyroidism are often asymptomatic, the diagnosis is often made incidentally in routine laboratory testing. METHODS This review is based on a selective search in PubMed for publications on the diagnosis and treatment of latent hypothyroidism. All pertinent articles and guidelines published from 1 January 2000 to 31 July 2016 were included. RESULTS The diagnosis of latent hypothyroidism is generally assigned after repeated measurement of a TSH concentration above 4.0 mU/L in a person whose fT4 concentration is in the normal range. The most common cause is autoimmune thyroiditis, which can be detected by a test for autoantibodies. L-thyroxin supplementation is a controversial matter: its purpose is to prevent the development of overt hypothyroidism, but there is a danger of overtreatment, which increases the risk of fracture. To date, no benefit of L-thyroxin supplementation has been demonstrated with respect to morbidity and mortality, health-related quality of life, mental health, cognitive function, or reduction of overweight. There is, however, evidence of a beneficial effect on cardiac function in women, and on the vascular system. At present, treatment is generally considered indicated only if the TSH level exceeds 10.0 mU/L. CONCLUSION Limited data are available on the relevant clinical endpoints and undesired side effects of supplementation therapy. Physicians should advise patients about the indications for such treatment on an individual basis after due consideration of the risks and benefits.

Comparison of Collegial Individual and Group Reviews of General Practice Multiple Choice Questions

Aims: In most German medical faculties, credits in general practice can be earned via exams using multiple-choice questions (MCQ). Measures such as peer-reviews may help assure the quality of these exams. In order to use time and personnel intensive peer reviews effectively and efficiently, the procedures used are key. Therefore, we wanted to find out whether there are differences between group and individual reviews regarding defined parameters. Methods: We conducted a controlled cross-over study with three GP reviewers from four different German universities. Each reviewed 80 MCQs, 40 individually and 40 within a group, including external assessments by a panel of experts. Furthermore all reviewers were asked to evaluate the review process and the time spent carrying out these reviews. Outcomes: We found no significant differences between the reliability and the validity of individual reviews versus group reviews. On average slightly more time was spent on group reviews compared with the individual reviews. The subjective assessments of the study participants regarding their satisfaction with the process and the efficiency and effectiveness of the reviews suggest a preference for group reviews. Conclusions: Based on this study, there are no definite recommendations for or against either approach. When choosing between the two, the specific work structures and organisation at the local faculty should be taken into account.

Impfstatus bei Pflegepersonal

Background: Health care workers can be multiplicators for infectious diseases due to their patient contacts. Vaccinations are not mandatory in Germany but there are recommendations for people at higher risk such as health care workers. There is no representative data regarding vaccination status of health care workers in Germany. Aim: We examined vaccination status among nurses regarding diphtheria, tetanus, pertussis, poliomyelitis, hepatitis A (HA) and hepatitis B (HB) as well as correlations between age, professional years, vaccination status and acceptance. Methods: An anonymous cross sectional survey concerning health burden and health behavior including vaccination was conducted among health care workers. Statistical analysis using SPSS included descriptive analysis, subgroup specific differences of distribution were tested by chi2-tests. Results: Regardless of age or professional years, 99 % of the nurses evaluated that vaccinations are at least “partly necessary”. Sufficient vaccination status was reported more often concerning tetanus (82 %) and HB (70 %) but less often regarding diphtheria (52 %), poliomyelitis (49 %), HA (43 %) and pertussis (42 %). With respect to some vaccinations, proportion of nurses not knowing their vaccination status was higher than 20 %. Conclusions: Despite the high vaccination acceptance, vaccination status among participating nurses was not sufficient. Implementation of vaccination measures targeting health care workers should be strengthened to reach higher vaccination coverages to prevent vaccination preventable infectious diseases among health care workers and patients in hospitals.

Correspondence (letter to the editor): Relevance of prevalence values.

Regarding the healthcare delivered to patients with euthyroid goiter in general practice, and on the basis of our own research experience in developing a guideline on thyroid disorders in general practice for the German College for General Practitioners and Family Physicians (Deutsche Gesellschaft fur Allgemeinmedizin, DEGAM), we wish to draw attention to the following. We have noticed with some surprise that, for some years now, authors of German scientific articles have been citing the Papillon study when reporting the prevalence rates of goiter and thyroid nodules for the German population. What remains completely unconsidered is the question of the relevance of these prevalence values for the German population. When looking at the selection of the study participants, for example (voluntary participation of “people in work,” who themselves (!) reported no prior thyroid-related findings), one may assume a high selection bias. These prevalence rates are not representative for the German population. Most cases of goiter are asymptomatic. Do all persons with asymptomatic changes of the thyroid (mostly incidental findings) have to be referred for further diagnostic/therapeutic measures? Or is watchful waiting sufficient, provided the patients have received comprehensive information? It is worth mentioning that thyroid cancer is rare. Estimated, age-standardized incidence rates of thyroid cancer according to the Robert Koch-Institute are 3.1/100 000 in men and 6.3/100 000 in women (1). Most thyroid changes are of benign origin (23). Against the background of very low incidence rates, the question arises of how effective further diagnostic measures are, especially in cases of asymptomatic euthyroid goiter. Their predictive value is too low due to the very low prevalence rates, especially in general practice. On the basis of the current state of knowledge, the DEGAM guideline for thyroid disorders will appeal to general practitioners to adopt an approach of watchful waiting in patients with asymptomatic thyroid changes (always depending on the clinical symptoms, in accordance with patients’ own wishes, and provided comprehensive information has been given).